Bill Van Auken
Today marks the first anniversary of the magnitude 7.0 earthquake that devastated the impoverished Caribbean nation of Haiti, leaving a quarter of a million of its people dead, more than 300,000 injured, and approximately a million and a half homeless.
One year after this natural disaster, the horrors facing Haiti’s population have only deepened, with a cholera epidemic claiming thousands of lives and a million left stranded in squalid tent camps.
This festering crisis underscores the social and political sources of the suffering inflicted upon Haiti’s working class and oppressed masses. That such conditions prevail virtually on the doorstep of the United States, which concentrates the greatest share of the world’s wealth, constitutes a crime of world historic proportions and an indictment of the profit system.
Those familiar with the conditions on the ground in Haiti provide an appalling account of the indifference and neglect of American and world imperialism toward the country’s people.
“The mountains of rubble still exist; the plight of the victims without any sign of acceptable temporary shelter is worsening the conditions for the spread of cholera, and the threat of new epidemics becomes more frightening with each passing day,” said former Jamaican Prime Minister P.J. Patterson, the Caribbean community’s special representative to Haiti. “In short, there has been no abatement of the trauma and misery which the Haitian populace has suffered.”
Roland Van Hauwermeiren, country director for the NGO Oxfam in Haiti, described 2010 as “a year of indecision” that had “put Haiti’s recovery on hold.” He added, “Nearly one million people are still living in tents or under tarpaulins and hundreds of thousands of others who are living in the city’s ruins still do not know when they will be able to return home.”
Of the approximately one million people living in makeshift tents or under tarps in the crowded camps of Port-au-Prince, more than half are children.
The Haitian capital remains buried in rubble. It is estimated that less than 5 percent of the debris has been cleared by Haitian workers attacking the mountains of fallen concrete and twisted metal with shovels and their bare hands. Heavy equipment has not been present in any significant amount since the withdrawal of the US military more than six months ago.
At its height, the US deployed some 22,000 soldiers, Marines, sailors and airmen in Haiti, seizing unilateral control of the country’s main airport, port facilities and other strategic facilities. The US military’s priority was to secure the country against the threat of popular upheaval and to deploy a Coast Guard and naval force to prevent Haitian refugees from making their way to the US.
To those ends, in the critical first weeks after the earthquake when aid was most needed to prevent loss of life and limb for the hundreds of thousands of injured, the Pentagon repeatedly turned away planes carrying medial aid and personnel in order to keep runways free for US military assets.
Within just 11 days of the earthquake, the US-backed Haitian government of President Rene Preval declared the search and rescue operation over—with only 132 people having been pulled alive from the rubble. Had an adequate response been organized, many more could have been saved. Decisions were taken in Washington based not on humanitarian considerations, but rather on the cold calculus of national interests and profits. Undoubtedly, this included the calculation that rescuing injured Haitians would only create a further drain on resources.
In contrast, the spontaneous response of the people of the United States and the entire world was one of solidarity with the suffering Haitian masses. An unprecedented outpouring of support yielded $1.3 billion in contributions from the US alone, the vast majority of it coming from ordinary working people.
One year later, however, just 38 percent of those funds have actually been spent to aid in the recovery and rebuilding of Haiti, according to a survey by the Chronicle of Philanthropy. In Haiti, there are widespread suspicions that vast amounts of money have been diverted into the coffers of NGOs and aid organizations.
Even worse is the response of governments. At a donors’ conference convened in March of last year, more than $5.3 billion was pledged. Of that, only $824 million has been delivered. Worst of all is the response of Washington, which pledged $1.15 billion for 2010, only to subsequently announce that it was postponing payment of virtually the entire pledge until 2011.
Last July, former US President Bill Clinton, who serves as the Obama administration’s envoy to Haiti, the UN’s special envoy to the country and the co-chair together with Haitian Prime Minister Jean-Max Bellerive of the Interim Haiti Recovery Commission (IHRC), expressed frustration over the slow pace of the payments and promised to pressure donors to make good on their promises. Apparently he has had little success in this effort, including with his own wife, Secretary of State Hillary Rodham Clinton. He has repeatedly made it clear that the only acceptable path to Haiti’s reconstruction lies through private investment and the assurance of profitable conditions—based largely on starvation wages--for US-based banks and transnationals.
On top of the earthquake’s devastation has come an epidemic of cholera, which has already claimed 3,600 lives and is expected to infect at least 400,000 people. Public health experts acknowledge that the spread of the disease has still not peaked, yet the terrible toll of this disease merits barely a mention in the US media.
The Obama administration’s indifference to Haitian life has been underscored by the decision to resume deportations to the country, with 350 Haitians slated to be sent back this month. With many of these people destined for incarceration in Haitian jails, which are rampant with cholera, the action amounts to a death sentence.
The epidemic is not a product of the earthquake, but rather, like the extraordinarily high death toll from the quake itself, the outcome of grinding poverty and backwardness resulting from the domination of Haiti by imperialism and, in particular, the role played by the US government and American banks and corporations over the past century.
Haiti is by far the poorest country in the Western Hemisphere. Even before the earthquake, less than half of the urban population and less than a fifth of those in rural areas had access to sanitation, leaving the country vulnerable to cholera. Prior to the quake, nearly three quarters of the Haitian populace was living on less than $2 a day, while barely 20 percent had jobs in the formal economy and 86 percent of urban dwellers were housed in slums.
These conditions are inextricably bound up with an oppressive political and social order that was forged through the US military occupation from 1915 to 1934, the savage 30-year dictatorship of the US-backed Duvalier dynasty, and the subsequent enforcement of so-called "liberal free market" policies by Washington and the International Monetary Fund.
The growing frustration and anger of the Haitian people over the criminal policies of Washington and the country’s narrow and corrupt financial elite have erupted repeatedly in mass resistance in recent months, first against the United Nations troops over the spread of cholera and then in response to the fraudulent November 28 election.
This popular resistance deserves the full support of working people in the US and internationally. The demand must be raised for immediate and massive aid to Haiti.
But aiding the people of Haiti and rebuilding the country on the basis of human needs rather than the interests of the native elite and the foreign banks and corporations can be achieved only by uniting the working class in Haiti, the US and throughout the hemisphere in a common fight for the socialist transformation of society.
12 January 2011
wsws
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Showing posts with label cholera epidemic Haiti. Show all posts
Showing posts with label cholera epidemic Haiti. Show all posts
Wednesday, January 12, 2011
Sunday, January 9, 2011
The cholera epidemic in Haiti
By Jean Herve Charles
I was travelling at the beginning of the month of October, from Port au Prince to Cape Haitian by public transportation when one of the travelers exchanged a phone call giving the information in the bus that eleven persons had died from food poisoning from a restaurant in Mirebalais, a bustling town not too far from the Dominican border. I would learn later it was not a case of food poisoning but the beginning of a cholera epidemic with the epicenter located near the Nepalese UN contingent stationed in that city.
Mirebalais is close to the Artibonite River, the largest and the longest Haitian river. Investigative research initiated by the French Health Ministry and conducted by a French specialist, Professor Renaux Piarroux, along with the Dean of the School of Public Health at Harvard University, has concluded that massive dumping of human waste from the UN base had compromised the quality of the water for regular use.
Notable institutions, including the Centers for Disease Control (CDC) in Atlanta, have hidden the origin of the disease with the lingo that ‘the source of the virus could not be determined with certainty”. The Swedish Ambassador Claes Hammar broke ranks with the wall of silence against Haiti that its own government has contributed to erect.
I have the information from reliable sources from the United States that the strain of cholera in Haiti is from the Nepal UN contingent in Haiti. It is up to the United Nations to reveal the whole truth about the genesis of the cholera.
The cholera germ could not find a hotter bed than Haiti to germinate with celerity and intensity. Public health as an institution and in practice does not exist in the entire country.
To facilitate the vein of corruption, the government has emasculated the power and the means of each local entity to clean its streets and the management of its waste, by creating an institution, the CNE, which is outside the purview of the legislative branch and of public scrutiny.
The CNE with massive equipment bought with the Caribe fund is using this material and its human resource with the prism of political priority not with the goal of providing the citizens of Haiti with a clean environment.
To add insult to injury the man in charge of that institution, Jude Celestin, is the dauphin groomed by the president of Haiti to become the next head of state of the Republic.
According to John Snow (1813- 1858), the father of the etymology of the disease, the cholera epidemic is, above all, a disease of contaminated water. You will find no city in Haiti, including the capital, equipped with a system for distributing potable drinking water. (The town of Petit Goave has just received a grant from Red Cross France to provide the city with drinking water.)
Close associates of the government are in the business of selling drinking water; as such the government should stay out of that business. DINEPA the new institution funded by the Spanish government to manage the water system in the country, does not have a policy of universal distribution of potable clean water.
The cholera disease has already caused the death of some 3,481 people with 80,000 in hospitalization. It is expected, according to the Pan American Health Organization to reach an effective 1 million people. The Cuban doctors, as well as Doctors Without Borders, have been in the frontline of the epidemic containment.
The term cholera, derived from the Greek word khole, is caused by a bacillus named vibrio cholera. It has its origin in the Indian continent near the squalor of the Ganges Delta. It spread from there through the silk trade to Russia in 1817, killing one million people. It went next to Germany, 1831, London and Paris in 1849 and returned to Russia in 1852. It is a dangerous infection that starts with a profuse watery diarrhea and vomiting of “a rice water with a fishy odor”. It can kill a person within hours, with circulatory collapse leading to a renal failure and certain death.
While the cholera disease is extremely dangerous, it can be treated easily with vaccine (85% effective), oral serum and, in the larger context, universal water purification, clean sewage and proper waste management system.
Haiti is postponing this radical operation to engage in the propaganda of cleaning hands and bottled water, while refuse and uncollected garbage is all over.
The earthquake of January 12, 2010, was an occasion for Haiti to rebuild itself. The cholera epidemic is another opportunity for Haiti to correct its deficient public health system. I have seen no clear signals that the Haitian government, along with the international community, is seizing the opportunity to create a new nation where cholera or any other disease or epidemic will have no quarter.
The Dominican Republic has registered already 139 cases of cholera. The epidemic respects no borders. A functioning and responsible leadership in Haiti is the best handicap against this modern scourge that enjoys squalor to spread its wings!
January 8, 2011
caribbeannewsnow
I was travelling at the beginning of the month of October, from Port au Prince to Cape Haitian by public transportation when one of the travelers exchanged a phone call giving the information in the bus that eleven persons had died from food poisoning from a restaurant in Mirebalais, a bustling town not too far from the Dominican border. I would learn later it was not a case of food poisoning but the beginning of a cholera epidemic with the epicenter located near the Nepalese UN contingent stationed in that city.
Mirebalais is close to the Artibonite River, the largest and the longest Haitian river. Investigative research initiated by the French Health Ministry and conducted by a French specialist, Professor Renaux Piarroux, along with the Dean of the School of Public Health at Harvard University, has concluded that massive dumping of human waste from the UN base had compromised the quality of the water for regular use. Notable institutions, including the Centers for Disease Control (CDC) in Atlanta, have hidden the origin of the disease with the lingo that ‘the source of the virus could not be determined with certainty”. The Swedish Ambassador Claes Hammar broke ranks with the wall of silence against Haiti that its own government has contributed to erect.
I have the information from reliable sources from the United States that the strain of cholera in Haiti is from the Nepal UN contingent in Haiti. It is up to the United Nations to reveal the whole truth about the genesis of the cholera.
The cholera germ could not find a hotter bed than Haiti to germinate with celerity and intensity. Public health as an institution and in practice does not exist in the entire country.
To facilitate the vein of corruption, the government has emasculated the power and the means of each local entity to clean its streets and the management of its waste, by creating an institution, the CNE, which is outside the purview of the legislative branch and of public scrutiny.
The CNE with massive equipment bought with the Caribe fund is using this material and its human resource with the prism of political priority not with the goal of providing the citizens of Haiti with a clean environment.
To add insult to injury the man in charge of that institution, Jude Celestin, is the dauphin groomed by the president of Haiti to become the next head of state of the Republic.
According to John Snow (1813- 1858), the father of the etymology of the disease, the cholera epidemic is, above all, a disease of contaminated water. You will find no city in Haiti, including the capital, equipped with a system for distributing potable drinking water. (The town of Petit Goave has just received a grant from Red Cross France to provide the city with drinking water.)
Close associates of the government are in the business of selling drinking water; as such the government should stay out of that business. DINEPA the new institution funded by the Spanish government to manage the water system in the country, does not have a policy of universal distribution of potable clean water.
The cholera disease has already caused the death of some 3,481 people with 80,000 in hospitalization. It is expected, according to the Pan American Health Organization to reach an effective 1 million people. The Cuban doctors, as well as Doctors Without Borders, have been in the frontline of the epidemic containment.
The term cholera, derived from the Greek word khole, is caused by a bacillus named vibrio cholera. It has its origin in the Indian continent near the squalor of the Ganges Delta. It spread from there through the silk trade to Russia in 1817, killing one million people. It went next to Germany, 1831, London and Paris in 1849 and returned to Russia in 1852. It is a dangerous infection that starts with a profuse watery diarrhea and vomiting of “a rice water with a fishy odor”. It can kill a person within hours, with circulatory collapse leading to a renal failure and certain death.
While the cholera disease is extremely dangerous, it can be treated easily with vaccine (85% effective), oral serum and, in the larger context, universal water purification, clean sewage and proper waste management system.
Haiti is postponing this radical operation to engage in the propaganda of cleaning hands and bottled water, while refuse and uncollected garbage is all over.
The earthquake of January 12, 2010, was an occasion for Haiti to rebuild itself. The cholera epidemic is another opportunity for Haiti to correct its deficient public health system. I have seen no clear signals that the Haitian government, along with the international community, is seizing the opportunity to create a new nation where cholera or any other disease or epidemic will have no quarter.
The Dominican Republic has registered already 139 cases of cholera. The epidemic respects no borders. A functioning and responsible leadership in Haiti is the best handicap against this modern scourge that enjoys squalor to spread its wings!
January 8, 2011
caribbeannewsnow
Monday, January 3, 2011
One year after: Taking stock of the Haitian recovery
By Jean Herve Charles
Every year at the beginning of the New Year I take time to stop, to take stock of the Haitian situation. Haiti has been going from bad to worse every year during those last ten years! It is true 2004 was also an annum miserabilis but the wave of misery fallen on the nation and the people of Haiti in 2010 was so frequent and so wide and deep that the year can be characterized as an annum miserabilissum.
At the dawn of the year, and the end of a magnificent tropical winter day filled with golden colors of the sun going to sleep on the hills surrounding Port au Prince, the land shook so violently under the capital and the adjoining cities that 300,000 people were found dead and 1.5 million have remained without a home. There was also inundation in the spring causing more damage to the land, followed by the seasonal hurricane during the summer.
As if it was not enough an imported germ of cholera from South Asia brought by one of the UN contingent into the country, has decimated some 3,000 people and sending 50,000 to hospital during the fall. The tropical winter has brought its lot of misery in the form of a political crisis when the Haitian government, supported by a sector of the international community, in particular the OAS-CARICOM team, has stolen the vote of the Haitian people thirsty of a life of peace and prosperity in one of the most beautiful place on earth.
The international media will descend en masse to Haiti on January 12, 2011 to make an assessment of the progress realized since the earthquake. They will be disappointed to find there was no progress according to the lowest standard of evaluation. Only 15 percent of the debris has been removed. The majority of the people are still living under tents, in fetid and dependent condition.
There was a massive outpouring of goodwill and financial support from the world community to Haiti. The Haitian government has exhibited a level of leadership so frail, mixed with a culture of corruption so deep, draped with complete indifference to the fate of its people that the enthusiasm of the donors and the NGOs has been reduced to naught.
The president of Haiti, Rene Preval, as well as his government led by Mr Bellerive, after two non consecutive mandates has no idea where he wants to lead his people. He is only concerned about remaining in power through a subaltern in order to dole out to associates and to partisans the spoils and the funds of the reconstruction without concern for the welfare of his citizens.
One would expect that the leadership vacuum in service delivery could have been filled by the myriad of non-governmental organizations that received the bulk of the funding raised for and on behalf of the Haitian people. Haiti is the perfect example that a nation cannot be developed harmoniously when the government as the main vehicle for service delivery has outsourced to NGOs the steering wheel to lead the growth process.
Case at point is the policy of building Corail (the biggest and the largest ghetto in the Caribbean) under the supervision and the expertise of the largest international NGOs such as Food for the Poor, International Red Cross, and Doctors Without Borders, etc.
Haiti’s recovery stands in the policy choice of building Corail or rebuilding the nation. So far the choice has been to rebuild Corail and ignore the rebuilding of the nation. The republic of Haiti with its 365 rural counties, its 142 towns, its 10 cities and the capital is either in complete ruin or has never been constructed. After January 12, 2010 Haiti had a chance to start de novo and rebuild itself. I am witnessing with the building of Corail, the compromising of the rebuilding of the rural villages, the towns and the cities of Haiti.
I have visited Corail on several occasions. On a rugged deserted hill facing Port au Prince, where you will not find one single tree, a sprawling new fevella or ghetto is being constructed, with homes designed by the international community no larger than a slave cell, while ignoring or feigning to ignore the fact that this agglomeration is ferment for future social explosion. The funding for this monstrosity should go instead to rebuild the town of Corail (a real agglomeration in the south of Haiti) as well as the other similarly situated 150 other towns of the nation.
The concept of nation building includes the concept of rooting the citizens in their own localities with their culture, the infrastructure, the institutions and the creative incubation to insure that they not become nomads in their own land. If the Haitian government has been delinquent in formulating and enforcing the policy of rooting their citizens at home in their towns or their villages, I would expect the international community, with funding from the good people of this earth, would know better!
I am observing a culture of map roule or faking diligence or disguised empathy practiced by both the Haitian government and the international community. The true beneficiaries of the avalanche of international NGOs in Haiti are the well wheeled Haitians who own a splendid villa for rent at the rate of $4,000 per month and/or a brand new 4/4 diesel jeep with a driver for rental at the rate of $4,500 per month.
Haiti has a window of opportunity this month and in the coming weeks to escape from its turbulent life of misery and squalor. The OAS as a corrupt incubator is multiplying its intervention in Haiti to keep alive a culture of death that is now sixty years old. It will become clearer for each and everyone to assess whether the international community is a foe or a friend of the Haitian people. It has in the past hijacked its political transition at each significant corner to maintain the economic strangulation.
The test will be whether the ghetto of Corail, right across the magnificent bay of Port au Prince shall continue to be a permanent fixture in the Haitian panorama or whether significant funding will trickle down into the rural villages, the towns and the cities of Haiti so the nation can rebuild itself on a permanent and sustainable basis!
The test will be also, whether the OAS/CARICOM tandem will succeed in reviving against the will of the people of Haiti, the Preval regime through a Siamese brother to maintain the misery of the majority of the population.
Stay tuned next week for an essay on: The epidemic of cholera and Haiti.
January 1, 2011
caribbeannewsnow
Every year at the beginning of the New Year I take time to stop, to take stock of the Haitian situation. Haiti has been going from bad to worse every year during those last ten years! It is true 2004 was also an annum miserabilis but the wave of misery fallen on the nation and the people of Haiti in 2010 was so frequent and so wide and deep that the year can be characterized as an annum miserabilissum.
At the dawn of the year, and the end of a magnificent tropical winter day filled with golden colors of the sun going to sleep on the hills surrounding Port au Prince, the land shook so violently under the capital and the adjoining cities that 300,000 people were found dead and 1.5 million have remained without a home. There was also inundation in the spring causing more damage to the land, followed by the seasonal hurricane during the summer. As if it was not enough an imported germ of cholera from South Asia brought by one of the UN contingent into the country, has decimated some 3,000 people and sending 50,000 to hospital during the fall. The tropical winter has brought its lot of misery in the form of a political crisis when the Haitian government, supported by a sector of the international community, in particular the OAS-CARICOM team, has stolen the vote of the Haitian people thirsty of a life of peace and prosperity in one of the most beautiful place on earth.
The international media will descend en masse to Haiti on January 12, 2011 to make an assessment of the progress realized since the earthquake. They will be disappointed to find there was no progress according to the lowest standard of evaluation. Only 15 percent of the debris has been removed. The majority of the people are still living under tents, in fetid and dependent condition.
There was a massive outpouring of goodwill and financial support from the world community to Haiti. The Haitian government has exhibited a level of leadership so frail, mixed with a culture of corruption so deep, draped with complete indifference to the fate of its people that the enthusiasm of the donors and the NGOs has been reduced to naught.
The president of Haiti, Rene Preval, as well as his government led by Mr Bellerive, after two non consecutive mandates has no idea where he wants to lead his people. He is only concerned about remaining in power through a subaltern in order to dole out to associates and to partisans the spoils and the funds of the reconstruction without concern for the welfare of his citizens.
One would expect that the leadership vacuum in service delivery could have been filled by the myriad of non-governmental organizations that received the bulk of the funding raised for and on behalf of the Haitian people. Haiti is the perfect example that a nation cannot be developed harmoniously when the government as the main vehicle for service delivery has outsourced to NGOs the steering wheel to lead the growth process.
Case at point is the policy of building Corail (the biggest and the largest ghetto in the Caribbean) under the supervision and the expertise of the largest international NGOs such as Food for the Poor, International Red Cross, and Doctors Without Borders, etc.
Haiti’s recovery stands in the policy choice of building Corail or rebuilding the nation. So far the choice has been to rebuild Corail and ignore the rebuilding of the nation. The republic of Haiti with its 365 rural counties, its 142 towns, its 10 cities and the capital is either in complete ruin or has never been constructed. After January 12, 2010 Haiti had a chance to start de novo and rebuild itself. I am witnessing with the building of Corail, the compromising of the rebuilding of the rural villages, the towns and the cities of Haiti.
I have visited Corail on several occasions. On a rugged deserted hill facing Port au Prince, where you will not find one single tree, a sprawling new fevella or ghetto is being constructed, with homes designed by the international community no larger than a slave cell, while ignoring or feigning to ignore the fact that this agglomeration is ferment for future social explosion. The funding for this monstrosity should go instead to rebuild the town of Corail (a real agglomeration in the south of Haiti) as well as the other similarly situated 150 other towns of the nation.
The concept of nation building includes the concept of rooting the citizens in their own localities with their culture, the infrastructure, the institutions and the creative incubation to insure that they not become nomads in their own land. If the Haitian government has been delinquent in formulating and enforcing the policy of rooting their citizens at home in their towns or their villages, I would expect the international community, with funding from the good people of this earth, would know better!
I am observing a culture of map roule or faking diligence or disguised empathy practiced by both the Haitian government and the international community. The true beneficiaries of the avalanche of international NGOs in Haiti are the well wheeled Haitians who own a splendid villa for rent at the rate of $4,000 per month and/or a brand new 4/4 diesel jeep with a driver for rental at the rate of $4,500 per month.
Haiti has a window of opportunity this month and in the coming weeks to escape from its turbulent life of misery and squalor. The OAS as a corrupt incubator is multiplying its intervention in Haiti to keep alive a culture of death that is now sixty years old. It will become clearer for each and everyone to assess whether the international community is a foe or a friend of the Haitian people. It has in the past hijacked its political transition at each significant corner to maintain the economic strangulation.
The test will be whether the ghetto of Corail, right across the magnificent bay of Port au Prince shall continue to be a permanent fixture in the Haitian panorama or whether significant funding will trickle down into the rural villages, the towns and the cities of Haiti so the nation can rebuild itself on a permanent and sustainable basis!
The test will be also, whether the OAS/CARICOM tandem will succeed in reviving against the will of the people of Haiti, the Preval regime through a Siamese brother to maintain the misery of the majority of the population.
Stay tuned next week for an essay on: The epidemic of cholera and Haiti.
January 1, 2011
caribbeannewsnow
Thursday, December 9, 2010
United Nations Stabilization Mission in Haiti (MINUSTAH) and the cholera epidemic
Reflections of Fidel
MINUSTAH and the epidemic
Taken from CubaDebate
MINUSTAH and the epidemic
Taken from CubaDebate
APPROXIMATELY three weeks ago news and footage came in of Haitian citizens throwing stones and angrily protesting against the forces of the MINUSTAH, accusing it of having transmitted cholera to that country via a Nepalese soldier.
The initial impression, if one did not receive any additional information, is that it was a rumor born from the antipathy that every occupying force provokes.
How could that information be confirmed? Many of us were unaware of the characteristics of cholera and its means of transmission. A few days later, the protests in Haiti ceased and there was no more talk of the matter.
The epidemic followed its inexorable course, and other problems, such as the risks associated with the electoral battle, occupied our time.
Today, reliable and credible news came in concerning what really happened. The Haitian people had more than sufficient reason to express their indignation.
The AFP news agency textually affirmed that: "Last month, the eminent French epidemiologist Renaud Piarroux headed an investigation in Haiti and came to the conclusion that the epidemic was generated by an imported strain, and extended from the Nepalese base" of MINUSTAH.
For its part, another European agency, EFE, reported: "The origin of the disease is to be found in the little town of Mirebalais, in the center of the country, where Nepalese soldiers had based their camp, and it appeared a few days after their arrival, which confirms the origin of the epidemic…"
"To date, the UN mission in Haiti (MINUSTAH) has denied that the epidemic entered via its blue berets."
"…French Dr. Renaud Piarroux, considered one of the principal world specialists in the study of cholera epidemics, leaves no doubt as to the origin of the disease…"
"The French study was ordered by Paris at the request of the Haitian authorities, stated a French diplomatic spokesperson."
"…the appearance of the disease coincides with the arrival of the Nepalese soldiers who, moreover, originate from a country where there is a cholera epidemic.
"There is no other way of explaining such a sudden and fierce eclosion of cholera in a little town of a few dozen inhabitants.
"The report also analyses the form of the propagation of the disease, given that fecal water from the Nepalese camp was draining into the river from which the town’s inhabitants take their water."
As the same agency communicated, the most surprising thing that the UN did was "…to send an investigative mission to the Nepalese camp, which concluded that that could not have been the origin of the epidemic."
In the midst of the destruction wrought by the earthquake, the epidemic and its poverty, Haiti cannot do without an international force which can cooperate with a nation ruined by foreign interventions and transnational exploitation. The UN must not only fulfill its elemental duty of fighting for Haiti’s reconstruction and development, but also that of mobilizing the resources needed to eradicate an epidemic that is threatening to extend to the neighboring Dominican Republic, the Caribbean, Latin America and other similar Asian and African countries.
Why did the UN insist on denying that the MINUSTAH brought the epidemic to the people of Haiti? We are not blaming Nepal, which in the past was a British colony, and whose men were utilized in its colonial wars and are now seeking employment as soldiers.
We made inquiries with the Cuban doctors currently providing services in Haiti and they confirmed to us the news circulated by the abovementioned European news agencies with notable precision.
I will make a brief synthesis of what was communicated to us by Yamila Zayas Nápoles, a specialist in comprehensive general medicine and anesthesiology, director of a medical institution that has eight basic specialties and diagnostic tools from the Cuba-Venezuela project, inaugurated in October 2009 in the urban area of Mirebalais, with 86,000 inhabitants, in the department of Nord.
On Saturday, October 15 three patients were admitted with symptoms of diarrhea and acute dehydration; on Sunday 16th, four were admitted with similar characteristics, but all of them from one family, and they made the decision to isolate them and communicate what had happened to the Medical Mission; surprisingly, on Monday 17th, 28 patients were admitted with similar symptoms.
The Medical Mission immediately sent a group of specialists in epidemiology who took blood, vomit, fecal samples and data, which were sent with urgency to Haiti’s national laboratories.
On October 22, the labs reported that the strain isolated matched to the one prevalent in Asia and Oceania, which is the most severe. The Nepalese unit of the UN blue berets is located on the bank of the Artibonite River, which runs through the little community of Méyè, where the epidemic emerged, and Mirebalais, to which it then rapidly spread.
In spite of the sudden way in which cholera appeared in the small, but excellent hospital in the service of Haiti, only 13 of the first 2,822 sick persons died, giving a mortality rate of 0.5%; subsequently, when the Cholera Treatment Center was set up in a remote area, out of 3,459 patients, five in a serious condition died, giving 0.1%.
The total number of persons suffering from cholera in Haiti rose today, Tuesday, December 7 to 93,222 persons, and the number of patients who have died reached a total of 2,120. Among those treated by the Cuban Mission the mortality rate rose to 0.83%. The mortality rate in other hospital institutions stands at 3.2%. With the experience acquired, appropriate measures and the reinforcement of the Henry Reeve Brigade, the Cuban Medical Mission, with the support of the Haitian authorities, has offered a presence in many of the isolated 207 sub-communes, so that no Haitian citizen lacks medical attention in the face of the epidemic, and many thousands of lives can be saved.
Fidel Castro Ruz
December 7, 2010
6:34 p.m.
granma.cu
Wednesday, December 8, 2010
Duty and the epidemic in Haiti
Reflections of Fidel
(Taken from CubaDebate)
(Taken from CubaDebate)
ON Friday, December 3, the UN decided to devote a session of the General Assembly to an analysis of the cholera epidemic in this neighboring country. The news of that decision was hopeful. Surely it would serve to alert international opinion to the gravity of the situation and mobilize support for the Haitian people. At the end of the day, its raison d’être is to confront problems and promote peace.
The current period in Haiti is grave, and the urgently required aid is little. Every year, our agitated world invests $1.5 trillion in arms and wars; Haiti – a country which less than one year ago suffered the brutal earthquake that resulted in 250,000 dead, 300,000 injured and enormous destruction – according to expert calculations, requires $20 billion for its reconstruction and ascending development, just 1.3% of what is spent in one year to those ends.
But now, it is not about that, which would constitute a simple dream. The UN is not only appealing for modest economic aid that could be resolved in a few minutes, but also for 350 doctors and 2,000 nurses, not possessed by the poor countries and whom the rich countries generally snatch from the poor ones. Cuba responded immediately, volunteering 300 doctors and nurses. Our Cuban Medical Mission in Haiti is treating close to 40% of those affected by cholera. In the wake of the call from that international organization, they rapidly took on the task of discovering the concrete causes of the high mortality rate. The low mortality rate of the patients whom they are treating is less than 1% – is reducing and will continue reducing every day – as compared to the 3% of persons treated in other health centers operating in the country.
It is evident that the number of deaths is not confined to the 1,800-plus people recorded. That figure does not include those who die without having gone to the existing doctors and heath centers.
Inquiring into the causes of those arriving in the most serious condition at the centers combating the epidemic and treated by our doctors, they observed that they came from the most distant sub-communes with the least communication. Haiti’s land surface is mountainous, and many isolated points can only be reached by moving over rugged ground.
The country is divided into 140 urban or rural communes, and 570 sub-communes. In one of the isolated sub-communes, where approximately 5,000 live – according to the Protestant pastor there – 20 people had died as a result of the epidemic without having attended a health center.
According to urgent investigations on the part of the Cuban Medical Mission in coordination with the national health authorities, it has been confirmed that 207 Haitian sub-communes in the most remote areas lack access to the centers fighting cholera or providing medical attention.
The abovementioned United Nations meeting ratified the need highlighted by Ms. Valerie Amos, UN Under-secretary General for Humanitarian Affairs and Emergency Relief, who made an urgent two-day visit to the country and calculated the figure of 350 doctors and 2,000 nurses. It was necessary to know the human resources existing in the country in order to calculate the number of personnel needed. That factor also depends on the hours and days devoted by the personnel fighting against the epidemic. One important fact to bear in mind is not only the time that they devote to their work, but the hour. The analysis of the high mortality rate reveals that 40% of deaths take place in nighttime hours, which points to affected patients not receiving the same attention to their disease during those hours.
Our mission estimates that the optimum use of personnel would reduce the abovementioned total. By mobilizing the available human resources of the Henry Reeve Brigade and the ELAM graduates that it has, the Cuban Medical Mission is convinced – even in the midst of the tremendous adversities originating from the earthquake destruction, the hurricane, unforeseeable heavy rainfall and the poverty – that the epidemic can be dominated and the lives of thousands of people who will inexorably die in the current circumstances, can be saved.
Sunday 28th was the date of elections for the presidency, the totality of the Chamber of Representatives and part of the Senate, a tense and complex event that seriously concerned us, given that it is related to the epidemic and the traumatic situation in the country.
In his statement on December 3, the UN secretary general stated textually: "Whatever the complaints or reservations about the process, I urge all political actors to refrain from violence and to start discussions immediately to find a Haitian solution to these problems – before a serious crisis develops," an important European news agency reported.
According to the same news agency, the secretary general appealed to the international community to complete the handover of $164 million, of which only 20% has been forthcoming.
It is not right to direct oneself to a country like someone who is scolding a little child. Haiti is a country that, two centuries ago, was the first in this hemisphere to end slavery. It has been the victim of all kinds of colonial and imperialist aggressions. It was occupied by the government of the United States barely six years ago after the latter promoted a fratricidal war. The existence there of a foreign occupation force, in the name of the United Nations, does not deprive that country of the right to respect for its dignity and its history.
We consider the position of the UN secretary general in appealing to Haitian citizens to avoid confrontations among themselves as correct. On November 28, at a relatively early hour, the opposition parties endorsed a call for street protests, thus provoking demonstrations and creating notable confusion within the country, particularly in Port-au-Prince; but, above all, outside of the country. Nevertheless, both the government and the opposition managed to avoid acts of violence. The following day the nation was calm.
The European agency stated that Ban Ki-moon had stated in relation to "last Sunday’s elections in Haiti […] that the ‘irregularities’ registered ‘now seem more serious than initially thought.’
Anyone who has read all the news coming in from Haiti and the latest statements of the main opposition candidates would find it impossible to understand that the person appealing for averting fratricidal fighting in the wake of the confusion created among voters in the run-up to the results of the count which will determine the two rival candidates in the January elections, is now saying that the problems were more serious than he initially thought, which is tantamount to fuelling the flames of political antagonisms.
Yesterday, December 4, was the 12th anniversary of the arrival of the Cuban Medical Mission in the Republic of Haiti. Since them, thousands of Cuban public health doctors and technical personnel have been providing services in Haiti. We have experienced with its people times of peace, or of war, earthquakes, hurricanes and cyclones. We will be with them in these times of intervention, occupation and epidemics.
The president of Haiti, the central and local authorities, whatever their religious or political ideas, know that they can count on Cuba.
Fidel Castro Ruz
December 5, 2010
8:12 p.m.
Translated by Granma International
granma.cu
Wednesday, December 1, 2010
News on cholera in Haiti
Reflections of Fidel
THERE is much to talk about when the United States is involved in a colossal scandal as a consequence of the documents published by Wikileaks, whose authenticity – independent of any other motivation on the part of that website – has not been questioned by anyone.
However, at this moment, our country is immersed in a battle against cholera in Haiti which, in its way, is becoming a threat for the rest of nations of Latin America and others in the Third World.
In the midst of the consequences of an earthquake that killed or wounded more than half a million people and caused enormous destruction, the epidemic broke out and, almost immediately, was aggravated by the calamity of a hurricane.
The number of persons affected by the disease rose yesterday, November 29, to 75,888, of whom 27,015 have been treated by the Cuban Medical Brigade, with 254 deaths, or 0.94%. The other state hospital facilities, NGOs and private, treated 48,875 people, of whom 1,721 died, indicating 3.03%.
Today, November 30, the Cuban Medical Mission which, incidentally, includes 201 graduates from the Latin American School of Medicine, treated 521 cholera patients, adding up to a total of 27,536.
Last Sunday, November 28, 18 people in a very critical condition arrived at the Cholera Treatment Center attached to the community reference hospital located in the L’Estère commune in Artibonite Department. They had come from a sub-commune called Plateau, and were immediately treated by the 11 doctors and 12 nurses from the Cuban Medical Brigade working there. Fortunately, they were able to save the lives of all of them.
On Monday 29th, 11 more patients arrived from the same sub-commune, among them, a child of five whose parents had died of cholera. Once again, their lives were saved.
Given that situation, Dr. Somarriba, head of the Medical Mission, decided to send an all-terrain vehicle with five doctors, two women nurses, one male nurse and a recovery therapist to the sub-commune, with the necessary resources for urgent attention to cases.
Of the five doctors, four are ELAM graduates: a Uruguayan, a Paraguayan, a Nicaraguan, a Haitian, and the head of the Cuban brigade in Artibonite department.
To reach the commune, they drove six kilometers by road, six more by causeway and, finally another two kilometers over rugged ground with all the equipment and resources on board to reach the commune.
Plateau is situated among five mountains with modest homes grouped at three points; the number of inhabitants is estimated at close to 5,000. There are no streets, nor electricity, nor businesses, as they informed us, and only one Protestant church.
The extremely poor population basically devotes itself to cultivating peanuts, corn, beans and squash.
When they reached Plateau, the church pastor offered to organize a treatment center within the church itself, with six cots and four pews of the faithful, which would allow the emergency admittance of 10 people.
Today eight were admitted, three in critical condition.
The neighbors say that around 20 people have died. That information does not appear in the official count of the dead. During the night they will work using the lamps they brought with them.
The Mission decided to set up a Cholera Treatment Center in that remote community, which will have 24 beds. All the resources will be sent tomorrow, including a generating plant.
They also informed that photo reporters came to the commune to see what was going on.
There were no deaths today, and another center, more to the north, has been opened, making for a total of 38 cholera treatment centers and units.
I am relating the case to explain the circumstances and methods of those waging the battle there against the epidemic which, with dozens of deaths every day, is already approaching 2,000 fatal victims.
With the working methods being implemented and the programmed reinforcement, it is unlikely that the number of dead will continue at the previous rate.
Knowing the passion with which the traditional electoral processes develop, aside from the typical abstentionism that characterizes many of them, we were concerned about what might happen in Haiti in the midst of the destruction and the epidemic. One basic and never violated principle is respect for the laws, parties and religious beliefs of the countries in which our doctors or the Henry Reeve Brigade are providing services.
Nevertheless, we were concerned about versions widely circulated by the international media presenting a scenario of generalized violence in the country, which was far from being the reality. The international observers were surprised at that news being divulged abroad, when in reality, for them, the events that did take place were isolated ones, affecting only a reduced percentage of citizens who exercised their vote.
The very leaders who called the people out onto the streets understood that, in the midst of the tragic situation in the country, it was not right to undertake actions that could provoke violent confrontations that would make it impossible to control and defeat the epidemic. If that objective is not achieved, it could become endemic and give rise to a health disaster in Haiti and a constant threat to the Caribbean, as well as to Latin America, where millions of poor people are accumulating in cities in growing numbers; and also for many other poor nations of Asia and Africa.
Moreover, do not ever forget that Haiti must be reconstructed from its foundations, with the help and cooperation of all. That is what we hope for its noble and selfless people.
Fidel Castro Ruz
November 30, 2010
9:34 p.m.
Translated by Granma International
granma.cu
Wednesday, November 17, 2010
The Haitian cholera outbreak: A preventable tragedy?
by Joseph Crupi, COHA Research Associate
On October 21, a case of cholera was identified in Haiti for the first time in at least 50 years. The disease spread rapidly through the Artibonite River basin, and by November 9, more than 580 people had died, and thousands more were gravely ill. The outbreak has raised questions about the international community’s efforts to prevent the spread of disease in post-earthquake Haiti, and many agencies and organizations have faced criticism for their failure to prevent the crisis. In order to evaluate the accuracy of these criticisms, it is important to carefully analyze the steps taken by health workers, governments, international organizations, and NGOs to prevent such a tragedy.
Health Workers Downplay Cholera Threat
In the aftermath of Haiti’s earthquake, the leaders of the international health community did not acknowledge cholera as a serious threat. On March 2, the Center for Disease Control and Prevention (CDC) published a report entitled “Acute Watery Diarrhea and Cholera: Haiti Pre-decision Brief for Public Health Action.” While the report recognized that water-borne diseases could easily spread through Haiti’s poorly-maintained tent cities, it also stated that an outbreak of “cholera [was] extremely unlikely to occur,” largely because the vibrio cholerae bacteria had not been observed in Haiti in over half a century. The report downplayed concerns that the bacteria could be introduced by foreign relief workers or aid shipments and failed to consider that the bacteria might continue to exist undiagnosed in rural communities. In a February radio interview, Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases, expressed agreement with the CDC report, saying, “There is no cholera in Haiti, so it would be extremely unlikely that there would be an outbreak of cholera in Haiti, even though you don’t want to completely rule it out, it’s not the first thing that you think of when you think of an outbreak of waterborne disease.”
Health care administrators, trusting the consensus among experts that a cholera outbreak was unlikely, concentrated on more pressing health concerns. Trauma injuries received first priority after the earthquake, and health care specialists also devoted much of their time and resources to treating patients suffering from diabetes, heart disease, HIV, and tuberculosis. Health workers placed a high emphasis on immunization campaigns to prevent measles, rubella, diphtheria, tetanus, and pertussis. A cholera vaccine was available at a cost of only 50 cents a dose, but due to the perceived improbability of an outbreak, health care administrators did not seriously consider widespread distribution to be necessary. Hence, while health workers had the technical capability to prevent an outbreak, they did not have compelling reasons to implement such measures.
Unmet Obligations and Broken Promises?
While health workers did not perceive cholera as an active threat in post-earthquake Haiti, other water-borne diseases did draw significant attention from health agencies. In February, the Pan American Health Organization (PAHO) reported, “Sanitation is a massive challenge that must be urgently resolved; an increasing number of diarrhea cases are being reported. If shelter and sanitation are not adequately addressed before the rainy season arrives, the risk of epidemic outbreaks of water-borne and other diseases will increase.” These issues, however, were not sufficiently addressed. In early September, PAHO conducted a survey of health systems in northern Haiti, where the first case of cholera was diagnosed, in order to “identify programs, needs, and gaps in coverage.” A report later released by the institution emphasized that “water and sanitation, provision of clean drinking water, and insufficient health care services” remained serious health issues in the region.
The persistence of these problems is due, in part, to the failure of foreign governments and international donor organizations to deliver aid efficiently. While a number of countries provided generous emergency relief immediately after the earthquake, many have been slow to fulfill promises of continued assistance for reconstruction and infrastructure development. Indeed, as of late September, only 15 percent of promised aid had reached Haiti. In many countries, legislative and bureaucratic processes have delayed further assistance. In the U.S., for example, Senator Tom Coburn has held up a five-year assistance authorization bill, and the State Department has delayed a USD 1.15 billion supplemental appropriations act that was signed by President Obama in late July.
However, the relevancy of these shortcomings to the current crisis is debatable, and it is not clear whether a more urgent allocation of foreign assistance would have significantly hindered the spread of cholera. Aid funds certainly could have been used to supply clean water and proper sanitation facilities, but it is unclear whether governments would have allocated funds to improve conditions in temporary settlements. Furthermore, given that donor institutions had primarily focused on areas directly affected by the earthquake, it is doubtful whether the funds would have been distributed effectively to close gaps in coverage.
Inadequate coordination between NGOs has also been detrimental to Haiti’s reconstruction effort. After the earthquake, various individual NGOs assumed responsibility for many of the tent cities occupied by those displaced by the earthquake, but there were no uniform standards or procedures in place to govern the distribution of resources among the camps. The capabilities of the NGOs in question varied widely, and as a result, some camps were adequately maintained, while others experienced catastrophic shortages of food and potable water. According to a joint study by the Institute for Justice and Democracy in Haiti, the University of San Francisco School of Law, and Lamp for Haiti, 44 percent of families in Haiti’s tent cities drink primarily untreated water, and only 9 percent received drinking water relief over a 30 day period. In most cases, clean water is only available to Haitians who can pay for it, and illnesses due to unsanitary water are common. The study also found that only 69 percent of Haitians in tent cities have access to basic toilet facilities, and toilets are often unclean, unsafe, and overcrowded.
While poor coordination among NGOs has exacerbated conditions in Haiti, it is unclear to what extent this shortcoming contributed to the cholera epidemic. Prior to the earthquake, much of the population lacked access to clean water and adequate waste management systems, and water-borne diseases were common. Thus, conditions were ripe for the spread of cholera even before the catastrophe. In the aftermath of the earthquake, over 160,000 Haitians were forced to resettle temporarily in the Artibonite region, where most of the cholera cases have been diagnosed. The increase in regional population has strained resources and compounded challenges in the removal of waste. While post-earthquake resettlement patterns certainly aggravated conditions that would facilitate the spread of cholera, it is difficult to determine to what extent the population shift has actually accelerated the spread of the disease. Cholera has just begun to infiltrate the tent cities,16 so conditions in the camps have not played a significant role in the outbreak thus far. However, cholera is now prevalent in Port-au-Prince, and it seems to be only a matter of time before the disease also becomes prevalent in the camps surrounding the capital. When the epidemic does make its way into the camps, the lack of a coordinated effort to provide clean water and proper sanitation will surely have devastating consequences.
Containment
Prior to the outbreak, the CDC had, in fact, developed a contingency plan to detect and respond to a cholera epidemic. The effort included the establishment of health monitoring sites to rapidly detect an outbreak of the disease. Proper methods of sample collection and analysis to confirm cases of cholera were also addressed in the plan, which provided several options for public health action should an outbreak occur. After the outbreak, the international community responded quickly to contain the disease. Soon after the first case was diagnosed, the CDC sent health experts to Haiti to conduct laboratory diagnoses. Cuba immediately dispatched several hundred doctors and nurses to administer antibiotics and assist those in need of treatment, and NGOs such as Médecins Sans Frontières set up cholera treatment centers and provided workers to staff local hospitals. Many of the public health options presented in the CDC report have been implemented, and containment objectives have been clearly defined.
The Haitian government, often criticized as corrupt and incompetent, has also done its part in responding to the outbreak. The Haitian Ministry of Health was first to detect the disease, and it has since played an active role in the containment effort. In addition, the government took decisive steps to help Haitians prepare for Hurricane Tomas and minimize the spread of cholera due to flooding from the storm.20
Conclusion
While the damage from the epidemic could certainly have been lessened by more anticipatory actions, it is unlikely that it could have been prevented completely. Health workers, operating under the assumption that a cholera outbreak was unlikely, understandably focused on more pressing concerns. While they may have had the capacity to significantly reduce the risk of an outbreak through vaccinations, health workers acted logically given the information they had. Although the failures of national, international, and nongovernmental organizations did not cause the outbreak, they may be partially responsible for the rapid spread of the disease. Whether or not poor coordination or delays in assistance actually facilitated the spread of the epidemic, as more Haitians are affected, increased (and long overdue) scrutiny of these shortcomings is inevitable. Reasonable preparations to contain a possible cholera epidemic were made in the months following the earthquake, and although it is premature to evaluate the international response, the effort to contain the disease seems to be well-coordinated.
According to PAHO deputy director Jon Andrus, cholera is not likely to be eradicated in Haiti for several years,21 and health workers have begun to prepare for a prolonged campaign against the disease. Speculation that Nepalese peacekeepers may have introduced the bacteria has led to protests and widespread anti-UN sentiment, which will likely inhibit the UN’s ability to operate effectively in the country. There are also fears that the flooding brought by Hurricane Tomas could expedite the spread of the disease, which is expected to eventually move across Haiti’s porous border with the Dominican Republic.22 Clearly, the international community must be fully committed to controlling the spread of the epidemic. While it is important to hold institutions accountable for any fault that may exist, excessive criticism at this juncture may be an overreaction. There is simply not enough available information to demonstrate the culpability of any one organization. Furthermore, attempts to assign blame for the crisis distract from and may even impede efforts to contain the disease. Given Haiti’s already unbearable suffering, it is imperative that the international community, the Haitian government, and its people are unified in their response to the cholera outbreak, which, if allowed to become a point of division, has the potential to make a dreadful situation even worse.
References for this article are available here
The Council on Hemispheric Affairs, founded in 1975, is an independent, non-profit, non-partisan, tax-exempt research and information organization. It has been described on the Senate floor as being "one of the nation's most respected bodies of scholars and policy makers." For more information, visit www.coha.org
November 17, 2010
caribbeannewsnow
On October 21, a case of cholera was identified in Haiti for the first time in at least 50 years. The disease spread rapidly through the Artibonite River basin, and by November 9, more than 580 people had died, and thousands more were gravely ill. The outbreak has raised questions about the international community’s efforts to prevent the spread of disease in post-earthquake Haiti, and many agencies and organizations have faced criticism for their failure to prevent the crisis. In order to evaluate the accuracy of these criticisms, it is important to carefully analyze the steps taken by health workers, governments, international organizations, and NGOs to prevent such a tragedy.
Health Workers Downplay Cholera Threat
In the aftermath of Haiti’s earthquake, the leaders of the international health community did not acknowledge cholera as a serious threat. On March 2, the Center for Disease Control and Prevention (CDC) published a report entitled “Acute Watery Diarrhea and Cholera: Haiti Pre-decision Brief for Public Health Action.” While the report recognized that water-borne diseases could easily spread through Haiti’s poorly-maintained tent cities, it also stated that an outbreak of “cholera [was] extremely unlikely to occur,” largely because the vibrio cholerae bacteria had not been observed in Haiti in over half a century. The report downplayed concerns that the bacteria could be introduced by foreign relief workers or aid shipments and failed to consider that the bacteria might continue to exist undiagnosed in rural communities. In a February radio interview, Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases, expressed agreement with the CDC report, saying, “There is no cholera in Haiti, so it would be extremely unlikely that there would be an outbreak of cholera in Haiti, even though you don’t want to completely rule it out, it’s not the first thing that you think of when you think of an outbreak of waterborne disease.”
Health care administrators, trusting the consensus among experts that a cholera outbreak was unlikely, concentrated on more pressing health concerns. Trauma injuries received first priority after the earthquake, and health care specialists also devoted much of their time and resources to treating patients suffering from diabetes, heart disease, HIV, and tuberculosis. Health workers placed a high emphasis on immunization campaigns to prevent measles, rubella, diphtheria, tetanus, and pertussis. A cholera vaccine was available at a cost of only 50 cents a dose, but due to the perceived improbability of an outbreak, health care administrators did not seriously consider widespread distribution to be necessary. Hence, while health workers had the technical capability to prevent an outbreak, they did not have compelling reasons to implement such measures.
Unmet Obligations and Broken Promises?
While health workers did not perceive cholera as an active threat in post-earthquake Haiti, other water-borne diseases did draw significant attention from health agencies. In February, the Pan American Health Organization (PAHO) reported, “Sanitation is a massive challenge that must be urgently resolved; an increasing number of diarrhea cases are being reported. If shelter and sanitation are not adequately addressed before the rainy season arrives, the risk of epidemic outbreaks of water-borne and other diseases will increase.” These issues, however, were not sufficiently addressed. In early September, PAHO conducted a survey of health systems in northern Haiti, where the first case of cholera was diagnosed, in order to “identify programs, needs, and gaps in coverage.” A report later released by the institution emphasized that “water and sanitation, provision of clean drinking water, and insufficient health care services” remained serious health issues in the region.
The persistence of these problems is due, in part, to the failure of foreign governments and international donor organizations to deliver aid efficiently. While a number of countries provided generous emergency relief immediately after the earthquake, many have been slow to fulfill promises of continued assistance for reconstruction and infrastructure development. Indeed, as of late September, only 15 percent of promised aid had reached Haiti. In many countries, legislative and bureaucratic processes have delayed further assistance. In the U.S., for example, Senator Tom Coburn has held up a five-year assistance authorization bill, and the State Department has delayed a USD 1.15 billion supplemental appropriations act that was signed by President Obama in late July.
However, the relevancy of these shortcomings to the current crisis is debatable, and it is not clear whether a more urgent allocation of foreign assistance would have significantly hindered the spread of cholera. Aid funds certainly could have been used to supply clean water and proper sanitation facilities, but it is unclear whether governments would have allocated funds to improve conditions in temporary settlements. Furthermore, given that donor institutions had primarily focused on areas directly affected by the earthquake, it is doubtful whether the funds would have been distributed effectively to close gaps in coverage.
Inadequate coordination between NGOs has also been detrimental to Haiti’s reconstruction effort. After the earthquake, various individual NGOs assumed responsibility for many of the tent cities occupied by those displaced by the earthquake, but there were no uniform standards or procedures in place to govern the distribution of resources among the camps. The capabilities of the NGOs in question varied widely, and as a result, some camps were adequately maintained, while others experienced catastrophic shortages of food and potable water. According to a joint study by the Institute for Justice and Democracy in Haiti, the University of San Francisco School of Law, and Lamp for Haiti, 44 percent of families in Haiti’s tent cities drink primarily untreated water, and only 9 percent received drinking water relief over a 30 day period. In most cases, clean water is only available to Haitians who can pay for it, and illnesses due to unsanitary water are common. The study also found that only 69 percent of Haitians in tent cities have access to basic toilet facilities, and toilets are often unclean, unsafe, and overcrowded.
While poor coordination among NGOs has exacerbated conditions in Haiti, it is unclear to what extent this shortcoming contributed to the cholera epidemic. Prior to the earthquake, much of the population lacked access to clean water and adequate waste management systems, and water-borne diseases were common. Thus, conditions were ripe for the spread of cholera even before the catastrophe. In the aftermath of the earthquake, over 160,000 Haitians were forced to resettle temporarily in the Artibonite region, where most of the cholera cases have been diagnosed. The increase in regional population has strained resources and compounded challenges in the removal of waste. While post-earthquake resettlement patterns certainly aggravated conditions that would facilitate the spread of cholera, it is difficult to determine to what extent the population shift has actually accelerated the spread of the disease. Cholera has just begun to infiltrate the tent cities,16 so conditions in the camps have not played a significant role in the outbreak thus far. However, cholera is now prevalent in Port-au-Prince, and it seems to be only a matter of time before the disease also becomes prevalent in the camps surrounding the capital. When the epidemic does make its way into the camps, the lack of a coordinated effort to provide clean water and proper sanitation will surely have devastating consequences.
Containment
Prior to the outbreak, the CDC had, in fact, developed a contingency plan to detect and respond to a cholera epidemic. The effort included the establishment of health monitoring sites to rapidly detect an outbreak of the disease. Proper methods of sample collection and analysis to confirm cases of cholera were also addressed in the plan, which provided several options for public health action should an outbreak occur. After the outbreak, the international community responded quickly to contain the disease. Soon after the first case was diagnosed, the CDC sent health experts to Haiti to conduct laboratory diagnoses. Cuba immediately dispatched several hundred doctors and nurses to administer antibiotics and assist those in need of treatment, and NGOs such as Médecins Sans Frontières set up cholera treatment centers and provided workers to staff local hospitals. Many of the public health options presented in the CDC report have been implemented, and containment objectives have been clearly defined.
The Haitian government, often criticized as corrupt and incompetent, has also done its part in responding to the outbreak. The Haitian Ministry of Health was first to detect the disease, and it has since played an active role in the containment effort. In addition, the government took decisive steps to help Haitians prepare for Hurricane Tomas and minimize the spread of cholera due to flooding from the storm.20
Conclusion
While the damage from the epidemic could certainly have been lessened by more anticipatory actions, it is unlikely that it could have been prevented completely. Health workers, operating under the assumption that a cholera outbreak was unlikely, understandably focused on more pressing concerns. While they may have had the capacity to significantly reduce the risk of an outbreak through vaccinations, health workers acted logically given the information they had. Although the failures of national, international, and nongovernmental organizations did not cause the outbreak, they may be partially responsible for the rapid spread of the disease. Whether or not poor coordination or delays in assistance actually facilitated the spread of the epidemic, as more Haitians are affected, increased (and long overdue) scrutiny of these shortcomings is inevitable. Reasonable preparations to contain a possible cholera epidemic were made in the months following the earthquake, and although it is premature to evaluate the international response, the effort to contain the disease seems to be well-coordinated.
According to PAHO deputy director Jon Andrus, cholera is not likely to be eradicated in Haiti for several years,21 and health workers have begun to prepare for a prolonged campaign against the disease. Speculation that Nepalese peacekeepers may have introduced the bacteria has led to protests and widespread anti-UN sentiment, which will likely inhibit the UN’s ability to operate effectively in the country. There are also fears that the flooding brought by Hurricane Tomas could expedite the spread of the disease, which is expected to eventually move across Haiti’s porous border with the Dominican Republic.22 Clearly, the international community must be fully committed to controlling the spread of the epidemic. While it is important to hold institutions accountable for any fault that may exist, excessive criticism at this juncture may be an overreaction. There is simply not enough available information to demonstrate the culpability of any one organization. Furthermore, attempts to assign blame for the crisis distract from and may even impede efforts to contain the disease. Given Haiti’s already unbearable suffering, it is imperative that the international community, the Haitian government, and its people are unified in their response to the cholera outbreak, which, if allowed to become a point of division, has the potential to make a dreadful situation even worse.
References for this article are available here
The Council on Hemispheric Affairs, founded in 1975, is an independent, non-profit, non-partisan, tax-exempt research and information organization. It has been described on the Senate floor as being "one of the nation's most respected bodies of scholars and policy makers." For more information, visit www.coha.org
November 17, 2010
caribbeannewsnow
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